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Fallon Health Clinical Pharmacist in Worcester, Massachusetts


About Fallon Health :

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit.

Brief Summary of Purpose:

Responsible for reviewing prescribed medications performing clinical and drug utilization reviews and clinical/economic evaluation of therapies and writing criteria sets for medications that have a prior authorization attached to them.

Responsible for designing and implementing clinical pharmacy programs and initiatives primarily for the PACE program. Position may require implementing programs and interventions for commercial and Medicaid products.


  • Perform total patient medication assessment as requested for new enrollees identifying interventions to address polypharmacy, drug-drug, drug-disease interactions, high risk medication use and non-adherence

  • Discuss medications with members/participants telephonically or in person

  • Implement programs and processes to improve medication related HEDIS and STAR measures

  • Identify opportunities for cost saving interventions utilizing high cost medication and medical cost lists

  • Review and provide clinical decisions for provider submitted prior authorizations for medically administered medications as well as pharmacy related appeals and grievances

  • Develop prior authorization criteria for new to market medications

  • Review and update existing prior authorization criteria

  • Present clinical and economic data to Pharmacy and Therapeutics committee

  • Perform in-services and provide drug information to PACE team and other internal and external stakeholders as needed

  • Participate in managing issues with medical and specialty drugs


Education, Licenses, certification and experience requirements:

Education : PharmD required

License : Current license to practice as pharmacist in Massachusetts without restriction

Certification : CGP Preferred

Experience : 5 years with at least one year in a managed care environment; 1-2 years Professional experience practicing as a clinical pharmacist

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 2 months ago (4/1/2020 9:33 AM)

Job ID 5967

# Positions 1

Category Pharmacy